Aims. The aim of this study was to determine the outcome of all primary total hip arthroplasties (THAs) and their subsequent revision procedures in patients aged under 50 years performed at our institution. Methods. All 1,049 primary THAs which were undertaken in 860 patients aged under 50 years between 1988 and 2018 in our tertiary care institution were included. We used cemented implants in both primary and revision surgery. Impaction bone grafting was used in patients with acetabular or femoral bone defects. Kaplan-Meier analyses were used to determine the survival of primary and revision THA with the endpoint of revision for any reason, and of revision for aseptic loosening. Results. The mean age of the patients at the time of the initial THA was 38.6 years (SD 9.3). The mean follow-up of the THA was 8.7 years (2.0 to 31.5). The rate of survival for all primary THAs, acetabular components only, and femoral components only at 20 years’ follow-up with the endpoint of revision for any reason, was 66.7% (95% confidence interval (CI) 60.5 to 72.2), 69.1% (95% CI 63.0 to 74.4), and 83.2% (95% CI 78.1 to 87.3), respectively. A total of 138 revisions were performed. The mean age at the time of revision was 48.2 years (23 to 72). Survival of all subsequent revision procedures, revised acetabular, and revised femoral components at 15 years’ follow-up with the endpoint of revision for any reason was 70.3% (95% CI 56.1 to 80.7), 69.7% (95% CI 54.3 to 80.7), and 76.2% (95% CI 57.8 to 87.4), respectively. A Girdlestone excision arthroplasty was required in six of 860 patients (0.7%). Conclusion. The long-term outcome of cemented primary and subsequent revision THA is promising in these young patients. We showed that our philosophy of using impaction bone grafting in patients with acetabular and
Aims. Revision total hip arthroplasty in patients with Vancouver type B3 fractures with Paprosky type IIIA, IIIB, and IV
Revision total hip arthroplasty (THA) is projected
to increase by 137% from the years 2005 to 2030. Reconstruction of
the femur with massive bone loss can be a formidable undertaking.
The goals of revision surgery are to create a stable construct,
preserve bone and soft tissues, augment deficient host bone, improve
function, provide a foundation for future surgery, and create a
biomechanically restored hip. Options for treatment of the compromised femur
include: resection arthroplasty, allograft prosthetic composite
(APC), proximal femoral replacement, cementless fixation with a
modular tapered fluted stem, and impaction grafting. The purpose
of this article is to review the treatment options along with their
associated outcomes in the more severe
The purpose of this prospective study was to
evaluate the long-term clinical and radiological outcomes of revision of
the femoral component of a total hip replacement using impaction
bone grafting. Femoral revision with an impacted allograft was performed
on 29 patients (31 hips). In all, 21 hips (68%) had grade III or
IV
We determined the midterm survival, incidence
of peri-prosthetic fracture and the enhancement of the width of
the femur when combining struts and impacted bone allografts in
24 patients (25 hips) with severe femoral bone loss who underwent
revision hip surgery. The pre-operative diagnosis was aseptic loosening
in 16 hips, second-stage reconstruction in seven, peri-prosthetic
fracture in one and stem fracture in one hip. A total of 14 hips
presented with an Endoklinik grade 4 defect and 11 hips a grade
3 defect. The mean pre-operative Merle D’Aubigné and Postel score
was 5.5 points (1 to 8). The survivorship was 96% (95% confidence interval 72 to 98) at
a mean of 54.5 months (36 to 109). The mean functional score was
17.3 points (16 to 18). One patient in which the strut did not completely
bypass the
We report our experience of revision total hip
replacement (THR) using the Revitan curved modular titanium fluted revision
stem in patients with a full spectrum of proximal
The aim of this study was to examine the implant accuracy of custom-made partial pelvis replacements (PPRs) in revision total hip arthroplasty (rTHA). Custom-made implants offer an option to achieve a reconstruction in cases with severe acetabular bone loss. By analyzing implant deviation in CT and radiograph imaging and correlating early clinical complications, we aimed to optimize the usage of custom-made implants. A consecutive series of 45 (2014 to 2019) PPRs for Paprosky III defects at rTHA were analyzed comparing the preoperative planning CT scans used to manufacture the implants with postoperative CT scans and radiographs. The anteversion (AV), inclination (IC), deviation from the preoperatively planned implant position, and deviation of the centre of rotation (COR) were explored. Early postoperative complications were recorded, and factors for malpositioning were sought. The mean follow-up was 30 months (SD 19; 6 to 74), with four patients lost to follow-up.Aims
Methods
There is a paucity of long-term studies analyzing risk factors for failure after single-stage revision for periprosthetic joint infection (PJI) following total hip arthroplasty (THA). We report the mid- to long-term septic and non-septic failure rate of single-stage revision for PJI after THA. We retrospectively reviewed 88 cases which met the Musculoskeletal Infection Society (MSIS) criteria for PJI. Mean follow-up was seven years (1 to 14). Septic failure was diagnosed with a Delphi-based consensus definition. Any reoperation for mechanical causes in the absence of evidence of infection was considered as non-septic failure. A competing risk regression model was used to evaluate factors associated with septic and non-septic failures. A Kaplan-Meier estimate was used to analyze mortality.Aims
Methods
In previous studies, we identified multiple factors influencing the survivorship of hip resurfacing arthroplasties (HRAs), such as initial anatomical conditions and surgical technique. In addition, the University of California, Los Angeles (UCLA) activity score presents a ceiling effect, so a better quantification of activity is important to determine which activities may be advisable or detrimental to the recovered patient. We aimed to determine the effect of specific groups of sporting activities on the survivorship free of aseptic failure of a large series of HRA. A total of 661 patients (806 hips) representing 77% of a consecutive series of patients treated with metal-on-metal hybrid HRA answered a survey to determine the types and amounts of sporting activities they regularly participated in. There were 462 male patients (70%) and 199 female patients (30%). Their mean age at the time of surgery was 51.9 years (14 to 78). Their mean body mass index (BMI) was 26.5 kg/m2 (16.7 to 46.5). Activities were regrouped into 17 categories based on general analogies between these activities. Scores for typical frequency and duration of the sessions were used to quantify the patients’ overall time spent engaging in sporting activities. Impact and cycle scores were computed. Multivariable models were used.Aims
Patients and Methods
Although good clinical outcomes have been reported for monolithic tapered, fluted, titanium stems (TFTS), early results showed high rates of subsidence. Advances in stem design may mitigate these concerns. This study reports on the use of a current monolithic TFTS for a variety of indications. A multi-institutional retrospective study of all consecutive total hip arthroplasty (THA) and revision total hip arthroplasty (rTHA) patients who received the monolithic TFTS was conducted. Surgery was performed by eight fellowship-trained arthroplasty surgeons at four institutions. A total of 157 hips in 153 patients at a mean follow-up of 11.6 months (SD7.8) were included. Mean patient age at the time of surgery was 67.4 years (SD 13.3) and mean body mass index (BMI) was 28.9 kg/m2 (SD 6.5). Outcomes included intraoperative complications, one-year all-cause re-revisions, and subsidence at postoperative time intervals (two weeks, six weeks, six months, nine months, and one year).Aims
Methods
This study presents the long-term survivorship, risk factors for prosthesis survival, and an assessment of the long-term effects of changes in surgical technique in a large series of patients treated by metal-on-metal (MoM) hip resurfacing arthroplasty (HRA). Between November 1996 and January 2012, 1074 patients (1321 hips) underwent HRA using the Conserve Plus Hip Resurfacing System. There were 787 men (73%) and 287 women (27%) with a mean age of 51 years (14 to 83). The underlying pathology was osteoarthritis (OA) in 1003 (75.9%), developmental dysplasia of the hip (DDH) in 136 (10.3%), avascular necrosis in 98 (7.4%), and other conditions, including inflammatory arthritis, in 84 (6.4%).Aims
Patients and Methods
Hip resurfacing arthroplasty (HRA) is an alternative to conventional
total hip arthroplasty for patients with osteonecrosis (ON) of the
femoral head. Our aim was to report the long-term outcome of HRA,
which is not currently known. Long-term survivorship, clinical scores and radiographic results
for 82 patients (99 hips) treated with HRA for ON over a period
of 18 years were reviewed retrospectively. The mean age of the 67
men and 15 women at the time of surgery was 40.8 years (14 to 64).
Patients were resurfaced regardless of the size of the osteonecrotic
lesion.Aims
Patients and Methods
The purpose of this retrospective study was to evaluate the minimum
five-year outcome of revision total hip arthroplasty (THA) using
the Kerboull acetabular reinforcement device (KARD) in patients
with Paprosky type III acetabular defects and destruction of the
inferior margin of the acetabulum. We identified 36 patients (37 hips) who underwent revision THA
under these circumstances using the KARD, fresh frozen allograft
femoral heads, and reconstruction of the inferior margin of the
acetabulum. The Merle d’Aubigné system was used for clinical assessment.
Serial anteroposterior pelvic radiographs were used to assess migration
of the acetabular component.Aims
Patients and Methods
Revision total hip replacement (THR) for young
patients is challenging because of technical complexity and the potential
need for subsequent further revisions. We have assessed the survivorship,
functional outcome and complications of this procedure in patients
aged <
50 years through a large longitudinal series with consistent treatment
algorithms. Of 132 consecutive patients (181 hips) who underwent
revision THR, 102 patients (151 hips) with a mean age of 43 years
(22 to 50) were reviewed at a mean follow-up of 11 years (2 to 26)
post-operatively. We attempted to restore bone stock with allograft
where indicated. Using further revision for any reason as an end point,
the survival of the acetabular component was 71% ( This overall perspective on the mid- to long-term results is
valuable when advising young patients on the prospects of revision
surgery at the time of primary replacement. Cite this article:
Tapered fluted titanium stems are increasingly
used for femoral revision arthroplasty. They are available in modular and
non-modular forms. Modularity has advantages when the bone loss
is severe, the proximal femur is mis shapen or the surgeon is unfamiliar
with the implant, but it introduces the risk of fracture of the
stem at the junction between it and the proximal body segment. For
that reason, and while awaiting intermediate-term results of more recently
introduced designs of this junction, non-modularity has attracted
attention, at least for straightforward revision cases. We review the risks and causes of fracture of tapered titanium
modular revision stems and present an argument in favour of the
more selective use of modular designs. Cite this article:
We have managed 27 patients (16 women and 11 men) with a mean age of 68.4 years (50 to 84), with failed total hip replacement and severe proximal femoral bone loss by revision using a distal fix/proximal wrap prosthesis. The mean follow-up was for 55.3 months (25 to 126). The mean number of previous operations was 2.2 (1 to 4). The mean Oxford hip score decreased from 46.2 (38 to 60) to 28.5 (17 to 42) (paired t-test, p <
0.001) and the mean Harris Hip score increased from 30.4 (3 to 57.7) to 71.7 (44 to 99.7) (paired t-test, p <
0.001). There were two dislocations, and in three patients we failed to eradicate previous infection. None required revision of the femoral stem. This technique allows instant distal fixation while promoting biological integration and restoration of bone stock. In the short term, the functional outcome is encouraging and the complication rates acceptable in this difficult group of patients.
The repair of chondral lesions associated with
femoroacetabular impingement requires specific treatment in addition
to that of the impingement. In this single-centre retrospective
analysis of a consecutive series of patients we compared treatment
with microfracture (MFx) with a technique of enhanced microfracture
autologous matrix-induced chondrogenesis (AMIC). Acetabular grade III and IV chondral lesions measuring between
2 cm2 and 8 cm2 in 147 patients were treated
by MFx in 77 and AMIC in 70. The outcome was assessed using the
modified Harris hip score at six months and one, two, three, four
and five years post-operatively. The outcome in both groups was
significantly improved at six months and one year post-operatively.
During the subsequent four years the outcome in the MFx group slowly deteriorated,
whereas that in the AMIC group remained stable. Six patients in
the MFx group subsequently required total hip arthroplasty, compared
with none in the AMIC group We conclude that the short-term clinical outcome improves in
patients with acetabular chondral damage following both MFx and
AMIC. However, the AMIC group had better and more durable improvement,
particularly in patients with large (≥ 4 cm2) lesions. Cite this article:
We have carried out in 24 patients, a two-stage revision arthroplasty of the hip for infection with massive bone loss. We used a custom-made, antibiotic-loaded cement prosthesis as an interim spacer. Fifteen patients had acetabular deficiencies, eight had segmental femoral bone loss and one had a combined defect. There was no recurrence of infection at a mean follow-up of 4.2 years (2 to 7). A total of 21 patients remained mobile in the interim period. The mean Merle D’Aubigné and Postel hip score improved from 7.3 points before operation to 13.2 between stages and to 15.8 at the final follow-up. The allograft appeared to have incorporated into the host bone in all patients. Complications included two fractures and one dislocation of the cement prosthesis. The use of a temporary spacer maintains the function of the joint between stages even when there is extensive loss of bone. Allograft used in revision surgery after septic conditions restores bone stock without the risk of recurrent infection.
We prospectively evaluated the long-term outcome of 158 consecutive patients who underwent revision total hip replacement using uncemented computer-assisted design-computer-assisted manufacture femoral components. There were 97 men and 61 women. Their mean age was 63.1 years (34.6 to 85.9). The mean follow-up was 10.8 years (10 to 12). The mean Oxford, Harris and Western Ontario and McMaster hip scores improved from 41.1, 44.2 and 52.4 pre-operatively to 18.2, 89.3 and 12.3, respectively (p <
0.0001, for each). Six patients required further surgery. The overall survival of the femoral component was 97% (95% confidence interval 94.5 to 99.7). These results are comparable to those of previously published reports for revision total hip replacement using either cemented or uncemented components.
If a surgeon is faced with altered lesser trochanter
anatomy when revising the femoral component in revision total hip
replacement, a peri-prosthetic fracture, or Paprosky type IIIb or
type IV femoral bone loss, a modular tapered stem offers the advantages
of accurately controlling femoral version and length. The splines
of the taper allow rotational control, and improve the fit in femoral
canals with diaphyseal bone loss. In general, two centimetres of diaphyseal
contact is all that is needed to gain stability with modular tapered
stems. By allowing the proximal body trial to rotate on a well-fixed
distal segment during trial reduction, appropriate anteversion can
be obtained in order to improve intra-operative stability, and decrease
the dislocation risk. However, modular stems should not be used for
all femoral revisions, as implant fracture and corrosion at modular
junctions can still occur. Cite this article: